RATIONALE. Since 1988, California has reduced smoking prevalence by 27% and cigarettes sold per adult by 45%. The size, timing, and social and financial benefits of resulting smokers' lung (chronic obstructive pulmonary disease (COPD)) mortality reductions have not been quantified nor contrasted with other states and countries. METHODS. State or country-specific smokers' lung death rates age-standardized to the 1940 US population (rates) were obtained from wonder.cdc.gov for 1979-1997 and other countries. We estimated the % gap each year (=(1-California rate/contrasting entity rate), averaged the % gaps for 1979-97, and t-tested whether the 1997 % gap was larger than the 1979-1996 average gap. Lives lost, early widowhoods, and early terminal cares costs due to not paralleling California's smokers' lung declines are equal to ((year-specific % gap - 1988% gap)*year-specific deaths in the contrasted entity), times .6/death to estimate widowhoods and $60,000/death to estimate early terminal care costs. RESULTS. From 1988-97, California smokers' lung rates fell from 15% above to 1% below the remaining US, a gap much reduced (p<.1) from historic averages. Had remaining US rates declined in parallel with California's, about 80,000 cumulative smokers' lung deaths, 36,000 early widowhoods, and $5 billion in early terminal care costs would have been averted to date. Most US states have similar, though lower absolute number, smokers' lung death excesses vs. California from 1988-97. CONCLUSIONS. California's reduced smoking was soon followed by substantial falls in: smokers' lung death rates, early widowhoods, and early death care costs. See www-epm.ucdavis.edu/~leistikow
Learning Objectives: 1.List 3 benefits of a healthy comprehensive tobacco control program. 2.Articulate a procedure for assessing the adequacy and impacts of their local, state, or national tobacco control program. 3. Benchmark their regions' smokers' lung trends and effects versus California trends.
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